Serum concentrations of brain-derived neurotrophic factor in patients with gender identity disorder.

Gender Identity Disorder (GID) is characterized by a strong and persistent cross-gender identification that affects different aspects of behavior. Brain-derived neurotrophic factor (BDNF) plays a critical role in neurodevelopment and neuroplasticity. Altered BDNF-signaling is thought to contribute to the pathogenesis of psychiatric disordersand is related to traumatic life events. To examine serum BDNF levels, we compared one group of DSM-IV GID patients (n = 45) and one healthy control group (n = 66). Serum BDNF levels were significantly decreased in GID patients (p = 0.013). This data support the hypothesis that the reduction found in serum BDNF levels in GID patients may be related to the psychological abuse that transsexuals are exposed during their life.

Prostate cancer: prediction of biochemical failure after external-beam radiation therapy--Kattan nomogram and endorectal MR imaging estimation of tumor volume.

PURPOSE: To determine whether magnetic resonance (MR) imaging and MR spectroscopic imaging findings can improve predictions made with the Kattan nomogram for radiation therapy. MATERIALS AND METHODS: The institutional review board approved this retrospective HIPAA-compliant study. Ninety-nine men who underwent endorectal MR and MR spectroscopy before external-beam radiation therapy for prostate cancer (January 1998 to June 2007) were included. Linear predictors were calculated with input variables from the study sample and the Kattan original coefficients. The linear predictor is a single weighted value that combines information of all predictor variables in a model, where the weight of each value is its association with the outcome. Two radiologists independently reviewed all MR images to determine extent of disease; a third independent reader resolved discrepancies. Biochemical failure was defined as a serum prostate-specific antigen level of 2 ng/mL (2 µg/L) or more above nadir. Cox proportional hazard models were used to determine the probabilities of treatment failure (biochemical failure) in 5 years. One model included only the Kattan nomogram data; the other also incorporated imaging findings. The discrimination performance of all models was determined with receiver operating characteristics (ROC) curve analyses. These analyses were followed by an assessment of net risk reclassification. RESULTS: The areas under the ROC curve for the Kattan nomogram and the model incorporating MR imaging findings were 61.1% (95% confidence interval: 58.1%, 64.0%) and 78.0% (95% confidence interval: 75.7%, 80.4%), respectively. Comparison of performance showed that the model with imaging findings performed significantly better than did the model with clinical variables alone (P < .001). Overall, the addition of imaging findings led to an improvement in risk classification of about 28%, ranging from approximately a minimum of 16% to a maximum of 39%, depending on the risk change considered important. CONCLUSION: MR imaging data improve the prediction of biochemical failure with the Kattan nomogram after external-beam radiation therapy for prostate cancer. The number needed to image to improve the prediction of biochemical failure in one patient ranged from three to six.

Polymorphic CAG and GGC repeat lengths in the androgen receptor gene and prostate cancer risk: analysis of a Brazilian population.

Variations in transcriptional activity of the androgen receptor (AR) are related to polymorphic CAG and GGC repeats in exon 1 of the AR gene. We investigated the association between CAG and GGC repeat length and the risk of prostate cancer in a case-control study from a Brazilian population. We evaluated 49 patients and 51 healthy controls. DNA was extracted from peripheral leukocytes and the AR gene was analyzed by fragment analysis (GeneMapper software, Applied Biosystems, Foster City, California, USA). CAG and GGC mean lengths were not different between cases and controls. The risk for prostate cancer was higher for CAG repeats < or = 21 (OR = 2.44 [95% CI 1.03-5.81]) as well as for total repeat lengths (CAG + GGC) < or = 37 (OR = 2.46 [95% CI 0.98-6.18]). GGC repeats (< or = 17 and > 17) were not associated with risk for prostate cancer (OR = 1.13 [95% CI 0.47-2.75]). In conclusion, fewer number of CAG repeats and total repeats (CAG + GGC) in the AR gene may be associated with increased risk for prostate cancer.

Phase I study with an autologous tumor cell vaccine for locally advanced or metastatic prostate cancer.

PURPOSE: To attempt the isolation and primary culture of prostate tumor cells, to use the cultured cells for active immunotherapy, and to evaluate the safety and efficacy in a Phase I clinical trial. MATERIALS AND METHODS: Tumor fragments were collected from 50 patients with prostate-specific antigen (PSA) > or = 10 ng/mL, < or = cT2 PCa who underwent radical retropubic prostatectomy (RRP) and 6 patients with metastatic PCa who underwent transurethral resection of the prostate (TURP). Cultured tumor cells were incubated with IFN-fi, irradiated, and cryopreserved. Seven vaccine inoculations were performed into > or = pT3 and/or N+ patients, and M+ patients, with the first two doses admixed with Bacille Calmette-Guerin (BCG). Follow-up was performed with measurement of delayed-type hypersensitivity (DTH) reactions, PSA and hemato-chemical tests, and bone scans. RESULTS: No cell culture was obtained in the TURP group. Cell culture and vaccine production were obtained in 37 cases (74%) in the RRP group. Eleven > or = pT3 and/or N+ patients were vaccinated. Toxicity was generally limited to the inoculation sites. DTH reactions > or = 10 mm were observed in 2 patients and > or = 5 mm in 6 patients. Two patients had a decrease in PSA levels after vaccine administration. CONCLUSIONS: The autologous cell vaccine is safe and seems to induce a positive immune cellular response. Primary cell culture and vaccine production can be obtained for most RRP patients, but not for TURP patients using our method. There seems to be some influence of the vaccine in PSA evolution after RRP.

[Profile of prostate cancer at the general hospital of Porto Alegre]. / Perfil do câncer de próstata no hospital de clínicas de Porto Alegre.

OBJECTIVES: To describe prevalence and features of prostate cancer in the sample. METHODS: A five year long voluntary screening program was carried out in the "Hospital das Clínicas de Porto Alegre" with the participation of 3,056 patients in a cross sectional study. For statistical analysis the chi square test was used, considering a significance level of p < 0.05 RESULTS: Mean age of the sample was of 60.4 years and prevalence of prostate cancer was of 2.61%, increasing with age. Sensitivity and specificity of PSA were respectively 93.8% (CI = 85.4% to 97.7%) and 82.5% (CI = 81.1% to 83.8%), considering 4 ng/ml as the cut-off point for PSA. Rectal examination had a sensitivity of 60% (CI = 48.4% to 70.6%) and a specificity of 83.3% (CI = 81.9% to 84.6%) The number of biopsies performed for the diagnosis of a patient with prostate cancer was 11.9 and varied according to age. As for clinical staging, 51.3% of patients were T1C and 83.75% of the tumors were clinically confined to the organ. CONCLUSION: Screening programs can be performed in our environment and direct to a frequent diagnosis of patients with prostate cancer confined to the organ.

Perfil do câncer de próstata no hospital de clínicas de Porto Alegre / Profile of prostate cancer at the general hospital of Porto Alegre

OBJETIVO: Determinar as características do adenocarcinoma prostático em um programa de rastreamento voluntário realizado no Hospital de Clínicas de Porto Alegre. MÉTODOS: Durante cinco anos consecutivos, 3.056 pacientes foram submetidos a um estudo transversal com o objetivo de determinar a prevalência e características do câncer de próstata na amostra. Foram biopsiados os pacientes com PSA = 4 ng/ml e /ou toque retal alterado. Para a análise estatística foi utilizado o teste qui-quadrado com nível de significância de p < 0,05. RESULTADOS: A prevalência do câncer de próstata foi de 2,61 por cento, sendo crescente com o aumento da idade. A taxa de positividade do PSA apresentou uma sensibilidade e especificidade do PSA foram, respectivamente, 93,8 por cento (IC = 85,4 por cento a 97,7 por cento) e 82,5 por cento (IC = 81,1 por cento a 83,8 por cento), utilizando como ponto de corte do PSA o valor de 4ng/ml. O toque retal apresentou sensibilidade de 60 por cento (IC = 48,4 por cento a 70,6 por cento) e especificidade 83,5 por cento (IC = 81,9 por cento a 84,6 por cento). O número de biópsias realizadas para se diagnosticar um paciente com câncer de próstata foi de 11,9 e variou conforme a faixa etária. No estadiamento clínico, 51,3 por cento dos pacientes eram T1C e 83,75 por cento dos tumores estavam clinicamente confinados ao órgão. CONCLUSAO: Programas de rastreamento de câncer de próstata em nosso meio são exeqüíveis e permitem diagnosticar com freqüência pacientes com neoplasia confinada ao órgão.

Recurrent priapism in the young patient treated with baclofen.

Recurrent priapism may lead to erectile dysfunction; its treatment is aimed at the prevention of new episodes. We report a case of idiopathic recurrent priapism in a 15-year-old patient. He was treated with oral baclofen, starting with a daily dose of 10mg that was increased to 30 mg to achieve control of symptoms. After a 6-month follow up, he reported no recurrence or side effects.

Assessment of serum level of prostate-specific antigen adjusted for the transition zone volume in early detection of prostate cancer.

OBJECTIVE: To determine the clinical usefulness of prostate-specific antigen (PSA) density in the transition zone (PSADTZ) for increasing the specificity in early detection of prostate cancer (PCa) and reducing unnecessary biopsies in males with PSA between 4.0 and 10 ng/mL. MATERIALS AND METHODS: This cross-sectional study obtained PSADTZ measurements in 68 patients with PSA between 4.0 and 10 ng/mL. All patients underwent transrectal ultrasonography (TRUS) with biopsies. PSADTZ was estimated by dividing the PSA value by the volume of the transition zone (TZ) obtained. We compared performance measurements for these parameters with those from the PSA itself, PSA density (PSAD) and free PSA/total PSA ratio (F/T PSA). The ability of the method in increasing PSA specificity was demonstrated and compared in univariate and multivariate analyses, and by Receiver Operating Characteristic Curves (ROC). RESULTS: Of the 68 patients under study, 17 (25%) were diagnosed with PCa. The TZ volume (p = 0.001) and PSADTZ (p = 0.001) variables presented means that exhibited statistically significant differences. When compared with the area under the curve (AUC), ROC curves obtained by this method revealed that PSADTZ was the strongest predictor for PCa when considering the cut-off point provided by the curve; that is, 0.35 ng/mL/cc. When PSADTZ was employed, the detection failure would be close to 20%, and less than 45% of cases would undergo unnecessary biopsies. On the other hand, when F/T PSA was used, the loss would reach almost 40%; however less than 30% would undergo unnecessary biopsies. Nevertheless, PSADTZ had the only AUC presenting p < 0.05 in significance when compared with 50%, and was consequently discriminative. CONCLUSIONS: PSADTZ increased PSA specificity in early detection of PCa in males with PSA between 4.0 and 10 ng/mL. However, it was shown to have lower predictive value and lower accuracy than the percentage of free PSA since it presents a higher negative predictive value than all other parameters assessed, and it can be considered clinically useful for reducing unnecessary indications for biopsy.

Assessment of serum level of prostate-specific antigen adjusted for the transition zone volume in early detection of prostate cancer

OBJECTIVE: To determine the clinical usefulness of prostate-specific antigen (PSA) density in the transition zone (PSADTZ) for increasing the specificity in early detection of prostate cancer (PCa) and reducing unnecessary biopsies in males with PSA between 4.0 and 10 ng/mL. MATERIALS AND METHODS: This cross-sectional study obtained PSADTZ measurements in 68 patients with PSA between 4.0 and 10 ng/mL. All patients underwent transrectal ultrasonography (TRUS) with biopsies. PSADTZ was estimated by dividing the PSA value by the volume of the transition zone (TZ) obtained. We compared performance measurements for these parameters with those from the PSA itself, PSA density (PSAD) and free PSA/total PSA ratio (F/T PSA). The ability of the method in increasing PSA specificity was demonstrated and compared in univariate and multivariate analyses, and by Receiver Operating Characteristic Curves (ROC). RESULTS: Of the 68 patients under study, 17 (25 percent) were diagnosed with PCa. The TZ volume (p = 0.001) and PSADTZ (p = 0.001) variables presented means that exhibited statistically significant differences. When compared with the area under the curve (AUC), ROC curves obtained by this method revealed that PSADTZ was the strongest predictor for PCa when considering the cut-off point provided by the curve; that is, 0.35 ng/mL/cc. When PSADTZ was employed, the detection failure would be close to 20 percent, and less than 45 percent of cases would undergo unnecessary biopsies. On the other hand, when F/T PSA was used, the loss would reach almost 40 percent; however less than 30 percent would undergo unnecessary biopsies. Nevertheless, PSADTZ had the only AUC presenting p < 0.05 in significance when compared with 50 percent, and was consequently discriminative. CONCLUSIONS: PSADTZ increased PSA specificity in early detection of PCa in males with PSA between 4.0 and 10 ng/mL. However, it was shown to have lower predictive value and lower accuracy than the percentage of free PSA since it presents a higher negative predictive value than all other parameters assessed, and it can be considered clinically useful for reducing unnecessary indications for biopsy.

Adenomatoid tumor of supra-renal gland

Adenomatoid tumors of adrenal gland are rare, asymptomatic neoplasias, with benign behavior, and usually are diagnosed incidentally. We report a case of a voluminous adenomatoid tumor of left adrenal gland in a 42-year old man who sought evaluation because of renal colic due to left nephrolithiasis. During the investigation, a tumor localized in left adrenal gland was identified by ultrasonography (14.3 x 10.5 x 19.0). The patient underwent adrenalectomy and pyelolithotomy with histopathological and immunohistochemical diagnosis of adenomatoid tumor of adrenal gland, being the largest one described in the literature to the moment. The patient does not present any signs of recurring lesion after a 3-year follow-up.

Adenomatoid tumor of supra-renal gland.

Adenomatoid tumors of adrenal gland are rare, asymptomatic neoplasias, with benign behavior, and usually are diagnosed incidentally. We report a case of a voluminous adenomatoid tumor of left adrenal gland in a 42-year old man who sought evaluation because of renal colic due to left nephrolithiasis. During the investigation, a tumor localized in left adrenal gland was identified by ultrasonography (14.3 x 10.5 x 19.0). The patient underwent adrenalectomy and pyelolithotomy with histopathological and immunohistochemical diagnosis of adenomatoid tumor of adrenal gland, being the largest one described in the literature to the moment. The patient does not present any signs of recurring lesion after a 3-year follow-up.

Nephrotoxic acute renal failure in a renal transplant patient with recurrent lymphocele treated with povidone-iodine irrigation.

Povidone-iodine sclerosis has been suggested in the literature as a safe and effective treatment for post-renal transplant lymphoceles. No significant complications of this method have been described. We report on a kidney allograft recipient with recurrent lymphoceles treated with povidone-iodine instillations who developed acute renal failure secondary to iodine intoxication. Four days after the beginning of the povidone-iodine irrigations, metabolic acidosis was present, and renal function started to deteriorate. After a few days, despite the suspension of irrigations, the patient developed oliguria, and dialysis was needed. A renal biopsy was performed, and intense acute tubular necrosis was the only relevant finding. The lymphocele was corrected surgically, and the patient eventually recovered. As has been described in other settings, povidone-iodine instillation for the treatment of post-renal transplant lymphoceles may lead to iodine kidney toxicity and acute renal failure.

Urodynamic alterations in patients with HTLV-1 infection.

OBJECTIVES: The HTLV-1 is a retrovirus that causes several diseases, including tropical spastic paraparesis or HTLV-1 associated myelopathy (or TSP/HAM, as designated by the World Health Organization - WHO) described in 1985. In Brazil, the first cases were reported in 1989. In order to evaluate the urodynamic alterations of infected patients, 48 cases were studied: 26 TSP/HAM and 22 non-TSP/HAM. MATERIAL AND METHOD: Evaluation was performed by testing, cystometry, abdominal pressure, differential pressure, detrusor leak point pressure, maximum flow pressure, and electromyography. RESULTS: 80.76% TSP/HAM patients showed hyperreflexic bladder, and 34.16% had detrusor-sphincter dyssinergia; 82.6% of this group had abnormal uroflow tests. Non-TSP/HAM patients had hyperreflexic bladders in 22.72% of the cases, and detrusor-sphincter dyssinergia was not assessed. For these patients, uroflow rate was normal in 70% of the cases. CONCLUSIONS: Patients infected by the HTLV-1, with or without myelopathy, present significant urodynamic abnormalities and must have a complete urologic and urodynamic evaluation.

Efficiency of short and long term antimicrobial therapy in transrectal ultrasound-guided prostate biopsies.

OBJECTIVE: Prostate biopsy is a frequent diagnostic measure to detect prostatic conditions, including primarily prostate cancer. Its performance does not follow a pattern, mainly regarding preparation for the examination through antimicrobial prophylaxis. The aim of this study is to compare the efficiency of short and long term antimicrobial prophylaxis in transrectal ultrasound-guided prostate biopsies. MATERIALS AND METHODS: A clinical study was conducted with a total of 140 patients submitted to prostate biopsy with transrectal ultrasonographic control. Patients were randomly separated in two groups: Group 1 receiving norfloxacin 400mg single dose before the procedure and Group 2 receiving norfloxacin 400mg initiating before the procedure and then bid up to 6 doses. Efficiency control was determined by the incidence of urinary tract infection (UTI) and complications in both groups after statistical analysis. RESULTS: The incidence of minor complications in our study was 75%, consistent with data found in the literature. Among the patients with diagnosis of simple UTI, 23% belonged to Group 1 and 8% to Group 2 (p=0.08). Among the patients with complicated UTI, 37% belonged to Group 1 and none belonged to Group 2 (p=0.44). CONCLUSIONS: Several advances made transrectal ultrasound-guided prostate biopsies a useful and safe diagnostic tool in the workup of urologic patients. There is no optimal prophylactic preparation to the performance of this procedure. Long term antimicrobial prophylaxis presents a trend toward lower incidence of infectious complications.

Avaliaçäo multicêntrica da eficácia e tolerabilidade do extrato lipidoesterólico de Serenoa repens em pacientes com hiperplasia prostática benigna sintomática / Efficacy and tolerability of the extract of Serenoa repens in a multicentric study in patients with symptomatic Benign Prostatic Hyperplasia

Objetivo: investigar a eficácia e a tolerabilidade do extrato lipoesterólico de Serenoa repens (LSESr) no tratamento da Hiperplasia Prostática Benigna (HPB). Métodos: estudo multicêntrico prospectivo, aberto, näo-controlado, realizado em 17 clínicas urológicas. Estudados 142 pacientes ambulatoriais com idade acima dos 50 anos e HPB sintomática, Pontuaçäo Internacional de Sintomas Prostáticos (I-PSS) maior ou igual a 8 na escala da OMS e taxa máxima de fluxo urinário menor ou igual a 12 ml/s para um volume urinário maior ou igual a 150 ml. Os pacientes receberam uma capsula de 160 mg do extrato lipidoesterólico de Serenoa repens duas vezes ao dia durante três meses. Avaliados I_PSS, índice de qualidade de vida (QV), urofluxometria e dosagem do antígeno prostático específico (PSA) sérico no início e ao término do estudo. Os efeitos colaterais foram registrados sistematicamente. A análise estatística foi realizada, utilizando-se um teste "t" pareado para avaliar a evoluçäo do I-PSS e da urofluxometria em D90 comparado ao D0. Obsevadas alteraçöes significativas nos parâmetros, nenhuma reaçäo adversa séria foi observada, outras reaçöes adversas leves e passageiras foram registradas em 10,56 porcento dos casos, principalmente gastrointestinais. Somente um paciente abandonou o tratamento devido à reaçäo adversa gastrointestinal. Näo houve diferença estatísticamente significante entre a média basal e final dos valores do PSA. Neste estudo o extrato lipidoesterólico da Serenoa repens demonstrou ser uma terapia medicamentosa da HPB com boa eficácia na sintomatologia e nas aferiçöes objetivas, além de ter sido muito bem tolerado pela grande maioria dos pacientes.(au)

Fibrose retroperitoneal: relato de dois casos e revisäo da literatura / Retroperitoneal fibrosis: relate of two cases and literature review

A fibrose retroperitoneal é uma doença rara, geralmente vista em pacientes com idade entre os 40 e 70 anose é secundária a um processo inflamatório crônico do retroperitôneo quepode comprimir os ureteres. A etiologia é desconhecida na maioria dos casos, ainda que vários fatores, como medicaçöes, doenças malignas einflamatórias, possamestar envolvidos. O diagnóstico de fibrose retroperitoneal deve ser considerado em pacientes com dor abdominal ou lombar e lesäo no retroperitôneo. Os sinais e sintomas säorelacionados com comprometimento de estruturas retroperitoneais como veia cava, aorta e ureteres. Quando ambos ureteres säo comprometidos, a insuficiência renal do tipo obstrutivo pode se desenvolver. Várias opçöes medicamentosas têm sido utilizadas nessas situaçöes. Apresentam-se neste trabalho dois casos de fibrose retroperitoneal: um deles idiopático e o outro, provavelmente, secundário a processo inflamatório crönico. Ambos foram submetidos a procedimentos cirúrgicos convencionais com a liberaçäo cirúrgica dos ureteres ou nefrostomia"au"

Validaçäo estatística do escore internacional de sintomas prostáticos (I-PSS) na língua portuguesa / Statistical validation of the international prostatic symptom score (I-PSS) in portuguese

Objetivo: Validar o I-PSS (International Prostatic Symptom Score) na língua portuguesa. Material e método: Um grupo de 281 pacientes com hiperplasia prostática benigna (HPB) foi avaliado com uma traduçäo portuguesa dos escores -PSS, QL (Qualidade de Vida) e BII (índice de impacto da HPB). Avaliou-se a confiabilidade teste-reteste, comparando-se os escores obtidos em dois momentos por meio do coeficiente de correlaçäo de Pearson e do teste "t" de Student; a consistência interna foi determinada através da estatística de Chronbach; e verificou-se a validade de constructo pela correlaçäo do I-PSS com os escores QL e BII através do coeficiente de correlaçäo de Pearson e modelos de regressao linear. A responsividade do instrumento foi avaliada em outro grupo de 49 pacientes submetidos a incisäo transuretral de próstata, comparando-se os escores I-PSS e QL pré e pós-operatórios por meio do teste "t" de Student. Resultados: Os coeficientes de correlaçäo em dois momentos dos escores I-PSS, QL e BII foram 0,843, 0,782 e 0,791 (p<0,0001), respectivamente. O I-PSS se correlacionou com os escores QL (r=0,687 p<0,0001) e BII (r=0,727 p<0,0001). O de Chronbach foi calculado em 0,816. As médias dos scores I-PSS e QL diminuíram de 22,71 e 4,04, antes da cirurgia, para 6,42 e 1,66, respectivamente, após a cirurgia (p<0,0001). Conclusäo: O I-PSS traduzido apresentou excelente desempenho psicométrico e pode ser utilizado como instrumento de mensuraçäo de sintomas de HPB no Brasil

Tratamento da infecçäo urinária aguda, näo complicada, em mulheres, com três dias de ciprofloxacina / Three-days treatment with ciprofloxacin for uncomplicated urinary tract infection in women

Trint pacientes do sexo feminino com mais de 18 anos de idade e infecçäo urinária näo complicada, foram tratadas com 250 mg de ciprofloxacina administrada duas vezes ao dia durante três dias. Os patógenos isolados foram E. coli em 20 casos; Proteus sp. em seis; Klebsiella/Enterobacter em dois e estafilococo em dois. Amostras de urina colhidas em três a cinco dias após o término do tratamento mostraram cura bacteriológicas em todas, mesmo em 10 pacientes com febre moderada, dor lombar uni bilateral ou ambas. Os efeitos colaterais, especialmente náuseas leves, dispepsia e dermatite alérgica, ocorreram em 26,6 por cento dos casos, mas foram de pouca expressäo clínica e näo obrigaram à suspensäo do fármaco

Rabdomiossarcoma embrionario de bexiga no idoso: relato de um caso / Embryonal rabdomiosarcoma of the bladder

Um caso de um paciente de 72 anos portador de rabdomiossarcoma embrionario de bexiga e apresentado com enfase na apresentaçao clinica. O tumor causava micçao interrompida devido a sua localizaçao exclusiva no domo vesical e enorme volume (250 g), obstruindo o colo vesical durante a micçao. O paciente conseguia urinar usando o toque retal para manter o tumor afastado do colo vesical. Devido a esta localizaçao, foi possivel submete-lo apenas a cistectomia parcial com preservaçao de 3/4 da bexiga e, portanto, de boa funçao vesical com margem de segurança adequada. O paciente encontra-se bem um ano apos a cirurgia, tendo a quimioterapia sido julgada desnecessaria